东非人类和牲畜的抗生素处方、配药和使用:道德是否起作用?

IF 1.6 Q2 ETHICS Monash Bioethics Review Pub Date : 2024-10-17 DOI:10.1007/s40592-024-00208-z
Edna Mutua, A Davis, E Laurie, T Lembo, M Melubo, K Mnzava, E Msoka, F Nasua, T Ndibohoye, R Zadoks, B Mmbaga, S Mshana
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引用次数: 0

摘要

背景:抗菌素耐药性(AMR)是对人类和牲畜健康的全球性威胁。虽然抗菌素耐药性是由抗菌素的使用引起的,但它往往被归咎于 "滥用 "和 "过度使用",尤其是抗生素。为了遏制抗药性,全球呼吁接受新形式的道德人格,践行 "正确 "使用,包括处方、配药和使用抗菌药物,尤其是抗生素。本文旨在反思有关道德如何嵌入/体现在急性呼吸道感染(AMR)论述中的复杂问题,正如所收集的有关坦桑尼亚人类和牲畜健康中抗菌药处方、配发和使用的数据所呈现的那样,主要侧重于抗生素:本思考以贾勒特-齐贡(Jarrett Zigon)的道德框架为基础,该框架由三个方面的话语组成:机构、公众和体现性处置。我们在这一框架内使用的数据来自一项定性研究,研究对象是坦桑尼亚北部的人类和动物医疗服务提供者及社区成员。我们通过 28 次深入访谈和 10 次焦点小组讨论收集数据,并在翻译和转录后通过内容分析对数据进行了分析。此外,还对坦桑尼亚的抗菌药耐药性国家行动计划进行了审查:结果:该框架的应用表明,坦桑尼亚国家行动计划所阐述的机构道德论述、公共论述以及人类和动物医疗保健服务提供者及社区成员的体现性处置/生活经验中存在着趋同和分歧点。我们证明,AMR 不仅与处方者、配药者和使用者的 "不当 "行为有关,还与卫生系统和服务提供方面的缺陷有关:结论:抗生素配发和使用方法可能与 AMR 的发展有关,不应脱离其发生的更广泛的健康背景来看待。
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Antibiotic prescription, dispensing and use in humans and livestock in East Africa: does morality have a role to play?

Background: Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to "misuse" and "overuse", particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice "proper" use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics. This paper seeks to reflect on complex questions about how morality has become embedded /embodied in the AMR discourse as presented in the data collected on antimicrobial prescription, dispensing and use in human and livestock health in Tanzania, primarily focusing on antibiotics.

Methods: This reflection is anchored on Jarrett Zigon's morality framework that is comprised of three dimensions of discourse; the institutional, public, and embodied dispositions. The data we use within this framework are derived from a qualitative study targeting human and animal health care service providers and community members in northern Tanzania. Data were collected through 28 in-depth interviews and ten focus group discussions and analysed through content analysis after translation and transcription. In addition, a review of the Tanzania's National Action Plans on antimicrobial resistance was conducted.

Results: Application of the framework demonstrates points of convergence and divergence in the institutional morality discourse articulated by the Tanzania National Action Plans, the public discourse and the embodied dispositions/ lived experiences of human and animal health care service providers and community members. We demonstrate that AMR is not just associated with "inappropriate" behaviour on the part of drug prescribers, dispensers, and users but also with shortcomings in health systems and service delivery.

Conclusion: Antibiotic dispensing and use practices that may be associated with the development of AMR should not be viewed in isolation from the broader health context within which they occur.

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来源期刊
CiteScore
2.70
自引率
6.20%
发文量
16
期刊介绍: Monash Bioethics Review provides comprehensive coverage of traditional topics and emerging issues in bioethics. The Journal is especially concerned with empirically-informed philosophical bioethical analysis with policy relevance. Monash Bioethics Review also regularly publishes empirical studies providing explicit ethical analysis and/or with significant ethical or policy implications. Produced by the Monash University Centre for Human Bioethics since 1981 (originally as Bioethics News), Monash Bioethics Review is the oldest peer reviewed bioethics journal based in Australia–and one of the oldest bioethics journals in the world. An international forum for empirically-informed philosophical bioethical analysis with policy relevance. Includes empirical studies providing explicit ethical analysis and/or with significant ethical or policy implications. One of the oldest bioethics journals, produced by a world-leading bioethics centre. Publishes papers up to 13,000 words in length. Unique New Feature: All Articles Open for Commentary
期刊最新文献
A duty to enhance? Genetic engineering for the human Mars settlement. Personal reflections on navigating plural values in the implementation of voluntary assisted dying in Victoria, Australia. Antibiotic prescription, dispensing and use in humans and livestock in East Africa: does morality have a role to play? Book review: ethics of artificial intelligence. Coercive public health policies need context-specific ethical justifications.
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